Proceedings of the NASS 19th Annual Meeting / The Spine Journal 4 (2004) 3S–119S14S

OUTCOME MEASURES: RTW, RTW at former occupation, and RTWat a lighter Physical Demand Level (PDL) rates are reported based onone year post-completion interviews. These results were compared to thesubject’s functional capabilities demonstrated upon leaving SPWC/H.METHODS: Subjects were contacted by telephone and completed thequestionnaire. 4 subjects were dropped at 1 yr post SPWC/H due to death,retirement due to age, and incarceration. These results were comparedwith subject’s lifting capabilities (PDL) demonstrated in SPWC/H. PDLwas categorized according to the U.S. Dept. of Labor’s Dictionary ofOccupational Titles: HEAVY�100 lbs., MEDIUM-HEAVY�75 lbs.,MEDIUM�50 lbs.RESULTS: PDL correlated with overall RTW rates at 1 yr follow-up(Cochran’s test, p�0.027). Subjects finishing at the HEAVY PDL (n�33)had a RTW rate of 100%, followed by MEDIUM-HEAVY (n�18) at 83.3%,and MEDIUM (n�20) at 85%. More importantly, PDL also correlated withRTW at former position rates (Cochran’s test, p�0.002): HEAVY at 78.7%,MEDIUM-HEAVY at 33.3%, and MEDIUM at 20%. These comparisonsshowed that full-duty RTW rates improved as level of function improved.CONCLUSIONS: Worker’s compensation subjects s/p lumbar fusion canattain meaningful levels of function and employment. These results suggestthat strength and technique obtained during SPWC/H has a direct carryover into the workplace. The RTW rates of this subject group are comparableto the published RTW rates of the general injured population, despitethe lumbar fusion procedure and the multi-factorial nature of the worker’scompensation system. This study suggests that SPWC/H produces effectiveRTW rates and a socioeconomic benefit to the worker’s compensationsystem with subjects s/p lumbar fusion. In addition, it shows that there isa direct correlation with level of function upon leaving SPWC/H and RTWrates at 1 yr post rehabilitation.DISCLOSURES: No disclosures.CONFLICT OF INTEREST: No Conflicts.

doi: 10.1016/j.spinee.2004.05.023

8:3623. Extreme pain ratings predict treatment failure in chronicoccupational spinal disordersTom Mayer, MD1, Donald Mcgeary, PhD2, Robert Gatchel, PhD1;1University of Texas Southwestern Medical Center at Dallas, Dallas,TX, USA; 2PRIDE Research Foundation, Dallas, TX, Dallas, TX, USA

BACKGROUND CONTEXT: Pain intensity is one of the most widely uti-lized outcome measures in the treatment of spinal disorders. Few studieshave comprehensively investigated how the role of pain intensity complaintcorrelates to the outcomes of spine treatment. No studies have quantitativelyassessed the subgroup of chronic disabling occupational spinal disorder(CDOSD) patients with extremely high pain report before or after tertiaryrehabilitation.PURPOSE: To evaluate a sample of CDOSD patients to determine theability of extremely high pain intensity ratings, measured by a visual analogscale (VAS), to identify patients at risk for poor outcomes.STUDY DESIGN/SETTING: A prospective case control study comparingoutcomes of patients with differing pain intensity in a functional restora-tion setting.PATIENT SAMPLE: A large cohort (N�3,106) of consecutively treatedCDOSD patients averaging 16 months of pre-rehab disability wereplaced into 4 pain intensity groups: Mild (ratings from 0–3 out of 10maximum), Moderate (4–5), Severe (6–7) and Extreme (8–10) based uponVAS pain intensity ratings.OUTCOME MEASURES: PRE- and POST-rehab standard psychosocialassessment measuring pain intensity, disability (Million VAS) and depres-sion (Beck Depression Inventory; BDI)). A structured clinical interviewexamining socioeconomic outcomes (work status, health utilization, andfinancial dispute resolution) was conducted one-year following programcompletion.METHODS: All patients underwent a medically-directed functional resto-ration program combining quantitatively-guided exercise progression witha multimodal disability management approach using psychological andcase management techniques.RESULTS: Prevalence of pain intensities in the 4 groups changed dramati-cally from PRE- to POST-rehab settings. Extreme pain dropped from 40%at PRE to 13% at POST, while mild ratings increased from 5% to 27% andmoderate from 18% to 33% at POST-rehab. PRE ratings helped identifythe dropout rate (p�.001), with the Extreme group only completing 83%of the time compared to 94% for the Mild group. Extreme PRE ratingsalso predicted higher POST pain, disability and depression, accompaniedby lower physical performance scores at treatment completion. POST scoreswere better than PRE scores in predicting one-year post-treatment socioeco-nomic outcomes (both with p�.001). Odds ratios were high and statisticallysignificant for all work, health utilization, recurrent injury and disputeresolution outcomes, comparing Extreme POST pain to Mild pain (all ORs�2). In particular, those with Extreme POST pain were 11 times morelikely to have additional surgical treatment and 4 times more likely neverto return to work, or to fail to retain work 1 year POST-rehab.CONCLUSIONS: The results of this study highlight that very high painintensity ratings can be useful in identifying CDOSD patients at risk for

8:2922. Does it matter which exercise? a multicentered RCT of low backpain subgroupsAudrey Long1, Ronald Donelson2*, Tak Fung1; 1Calgary, Alberta,Canada; 2Hanover, NH, USA

BACKGROUND CONTEXT: The role of “specific” exercises in manag-ing low back pain (LBP) is controversial. Also, identifying clinically rele-vant subgroups within the nonspecific LBP population would greatlyimprove care and future research.PURPOSE: To determine how contrasting exercise prescriptions wouldaffect pain and other related outcomes in validated LBP subgroups.STUDY DESIGN/SETTING: A multi-centered, randomized controlledtrial.PATIENT SAMPLE: Consecutive LBP patients (including acute, chronic,LBP-only, and sciatica with and without neurologic findings) seeking careat 11 physical therapy centers.OUTCOME MEASURES: Back and leg pain intensity and location,Roland-Morris Disability scores, medication use, Beck depression, workinterference, and perceived ability to return to work/recreation.METHODS: 312 patients underwent a standardized mechanical assessmentmonitoring patterns of pain response that identified two groups based onthe presence or absence of a “directional preference” (DP), a lasting benefi-cial pain response to lumbar flexion, extension, or sideglide/rotation testing.DP patients were then randomized to one of three exercise treatments: 1-directional exercises “matching” their preferred direction (DP), 2-exercisesdirectionally “opposite” to their DP, or 3-non-directional exercises. Multipleoutcome measures were obtained at baseline and two-weeks.RESULTS: 230 subjects (74%) demonstrated a DP and were randomized.While all three exercise treatment groups showed improvement in all mea-sures, there were significantly greater improvements in every outcome inthe Matched group compared with both other treatment groups (most p-values �.001), including a three-fold decrease in medication use. While no

Matched group member withdrew prematurely, one-third of both theOpposite and Non-Directional subjects withdrew due to either no im-provement or worsening.CONCLUSIONS: A standardized mechanical assessment focused on elic-iting patterns of pain response identified LBP subgroups that then respondedsignificantly differently to contrasting exercise prescriptions. Exercises“matching” subjects’ assessment findings were highly effective in improv-ing all measured outcomes, including pain intensity and medication use.Such subgroup validation, if repeatable, has important implications for bothLBP management and future research.DISCLOSURES: No disclosures.CONFLICT OF INTEREST: No Conflicts.

doi: 10.1016/j.spinee.2004.05.024